Surgical management of inguinal neuralgia after a low transverse Pfannenstiel incision.
OBJECTIVE
The authors assessed the long-term pain relief after local nerve blocks or neurectomy in patients suffering from chronic pain because of Pfannenstiel-induced nerve entrapment.


BACKGROUND
The low transverse Pfannenstiel incision has been associated with chronic lower abdominal pain because of nerve entrapment (2%-4%). Treatment options include peripheral nerve blocks or a neurectomy of neighboring nerves. Knowledge on adequate (surgical) management is scarce.


METHODS
Patients treated for iliohypogastric and/or ilioinguinal neuralgia after a Pfannenstiel incision received a questionnaire assessing current pain intensity (by 5-point verbal rating scale), complications, and overall satisfaction.


RESULTS
Twenty-seven women with Pfannenstiel-related neuralgia were identified between 2000 and 2007. A single diagnostic nerve block provided long-term pain relief in 5 patients. Satisfaction in women undergoing neurectomy (n = 22) was good to excellent in 73%, moderate in 14%, and poor in 13% (median follow-up, 2 years). Complications were rare. Successful treatment improved intercourse-related pain in most patients. Comorbidities (endometriosis, lumbosacral radicular syndrome) and earlier pain treatment were identified as risk factors for surgical failure.


CONCLUSIONS
Peripheral nerve blocking provides long-term pain reduction in some individuals. An iliohypogastric or ilioinguinal nerve neurectomy is a safe and effective procedure in most remaining patients.
Loos
Maarten J A
MJ
Department of General Surgery, Máxima Medical Centre, Veldhoven, The Netherlands. loosmaarten@hotmail.com
Scheltinga
Marc R M
MR
Roumen
Rudi M H
RM
D000005:Abdomen / Q000294:innervation; D000328:Adult; D000368:Aged; D000465:Algorithms; D002585:Cesarean Section; D003075:Coitus; D005260:Female; D005547:Foreign Bodies / Q000150:complications; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007044:Hysterectomy; D007264:Inguinal Canal / Q000294:innervation*; D008875:Middle Aged; D009407:Nerve Block; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000601:surgery; D009437:Neuralgia / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction; D010525:Peripheral Nerves / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013537:Sutures / Q000009:adverse effects; D016896:Treatment Outcome